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The pelvic organ prolapse quantification system (POP-Q) is the most commonly used method to quantify the extent of pelvic organ prolapse. However, it does not include assessment of anterior vaginal wall length (AVL). The objectives of this study were to characterize AVL and distance to the sacrospinous ligament (SSL), and to examine associations between total vaginal length (TVL), AVL, body mass index (BMI) and age. This was a retrospective chart review of 139 patients with cervix in situ presenting during an 8-month period for initial evaluation to the University of Rochester Medical Center Urogynecology practice. AVL, TVL and distance to the SSL were measured in addition to POP-Q measurements. Age, height, BMI, presenting complaint and prolapse stage were obtained from medical records. Simple linear regression was used to assess the relationship between TVL and AVL. Multivariate regression was used to test independent variables. The mean ± SD TVL, AVL and distance to the SSL were 9.4 ± 1.2 cm, 7.4 ± 0.9 cm and 7.2 ± 0.9 cm, respectively. All three measurements approached a normal distribution. TVL decreased slightly with age. No association was found between vaginal length and BMI or parity. AVL is a useful measurement that may aid in surgical decision-making. Providers should consider using AVL when planning sacrospinous hysteropexy.

Typical etiologies of vesicovaginal fistula (VVF) include obstructed labor, iatrogenic surgical injury, pelvic irradiation and cancer invasion. VVF caused by cystocele are very rare. To date, there are no documented cases in Japanese literature.A 74-year-old woman presented with near total incontinence. On physical examination, she was found to have severe cystocele and pressure necrosis of anterior vaginal wall, which caused partial breakdown of vaginal mucosa and VVF. She underwent vesicovaginal fistula repair using transvaginal and transabdominal approaches. Catheter drainage was performed for 10 days and postoperative cystogram showed no sign of leakage. She is currently symptom-free at 55 months.

A 2.5-year-old spayed female Siamese cat was presented with a recurrent exudative wound in the right perirectal fossa. Clinical examination at presentation revealed a 1 cm long open wound with purulent discharge in the right perirectal fossa but was otherwise unremarkable. A computed tomography contrast-enhanced study showed a tracking sinus which could be traced from the right dorsolateral perianal region right up to the level of the vagina. Surgical exploration was performed from the perirectal region. The intermuscular sinus tract, which formed a cystic structure and connected to the vaginal wall, was en bloc excised. Histopathological examination confirmed the diagnosis of a dermoid sinus in the perirectal fossa with vaginal infiltration. To the authors' knowledge, this is the first case report in the veterinary literature of the successful surgical management of a dermoid sinus in the perianal region connected to the vaginal wall in a cat.Eine 2,5 Jahre alte, weiblich-kastrierte Siamkatze wurde mit einer rezidivierenden exsudativen Wunde in der rechten perirektalen Region vorgestellt. Die klinische Untersuchung ergab mit Ausnahme einer 1 cm langen Wundöffnung mit purulentem Ausfluss in der rechten perirektalen Region keine Auffälligkeiten. Eine computertomographische Kontraststudie zeigte einen Sinustrakt, der von der rechten dorsalen perianalen Region bis auf Höhe der Vagina verfolgt werden konnte. Ausgehend von der perirektalen Region erfolgte eine chirurgische Exploration. Der intermuskuläre Sinustrakt, der eine zystische Struktur ausbildete und eine Verbindung zur Vaginalwand aufwies, wurde en bloc reseziert. Die histopathologische Untersuchung bestätigte die Diagnose eines Dermoidsinus in der perirektalen Region mit einer vaginalen Infiltration. Nach Kenntnis der Autoren ist dies der erste Fallbericht in der veterinärmedizinischen Literatur über eine erfolgreiche chirurgische Behandlung eines Dermoidsinus in der perirektalen Region mit Verbindung zur Vaginalwand bei einer Katze.

The G spot has been a myth since it was first described. It is not just a tiny spot but more an area located on the anterior vaginal wall about 3.8–4.2 cm from the pubic bone, and today there is not enough scientific data to support if G spot enhancer treatments are a good or valid option. Today we can enhance the G spot by injecting hyaluronic acid and plasma on the G spot area.

When thinking on a vaginal rejuvenation procedure, many believe it will be enough with a posterior vaginoplasty or even with only a perineoplasty, but we must never forget no two surgical plans can be identical since every patient is unique. Once again, it is very important to remember that a good assessment is the key for a happy patient. This is why, in many cases, patients will need more than one procedure done to really have an increase in sexual gratification. Remember the most important reason to have a vaginal rejuvenation procedure is to increase sexual gratification on both the woman and her partner. When a vaginal rejuvenation procedure is planned to only narrow the vaginal entrance (perineoplasty) or the vaginal canal (vaginoplasty), increased friction will be felt by the male partner, but for the woman, it can end up being even painful; this is why it is so important to plan a good procedure so that the woman can contract harder her vagina walls during sexual intercourse and, by doing so, increase sexual gratification for both the man and the woman. Ending up with a too tight area will give us the wanted result. By combining anterior and posterior vaginoplasty procedures with a perineoplasty, patients will be able to contract vaginal walls better, thus enhancing both female and male sexual gratification.

Purpose The purpose of this study was to report our experience regarding the development of a low-cost multichannel vaginal cylinder applicator for superficial and recurrent vaginal tumors. Methods and Materials The applicator mold was created by applying heated wax sheets in layers around a plastic tube. Interstitial stainless-steel needles were placed at equal distance around the mold surface to create multiple channels for treatment. Two plans were created using CT images for a patient with a recurrent tumor over the posterior vaginal wall for comparing single-channel and multichannel cylinder dosimetry. The doses received by the target (high risk clinical target volume) and organs at risk (OARs) were computed using dose–volume histograms. Results There was no significant difference in terms of the prescribed dose delivered to high risk clinical target volume between the two plans. The volume of the target receiving 150 and 200 percent (V150 and V200) dose was higher in the multichannel cylinder plan than the single-channel cylinder plan. In terms of doses to the OARs, there was no significant difference between the rectum doses (D2cc rectum). There was a significant reduction in the dose to the bladder (D2cc bladder), urethra (D0.1cc urethra), and uninvolved vagina (D2cc uninvolved vagina). Conclusions Multichannel vaginal cylinders reduce doses to the OARs as compared with the single-channel vaginal cylinder in superficial vaginal lesions limited to the wall of the vagina. Their use is limited by the cost of the applicator. Our low-cost multichannel vaginal cylinder can be used as a reliable alternative in such situations.

Pelvic organ prolapse is a common problem affecting up to 50% of women over the age of 50. The various methods of reconstructive pelvic organ prolapse surgery have been reported to be associated with long-term recurrence rates of up to 50%. Management of patients with repeated failure of different surgical procedures is often challenging. Obliterative surgery can be an option for women with a POP-Q stage 2 or larger genital prolapse who are not sexually active. The video of the procedure shows how to address enterocele with frail and puffy vaginal epithelium of the posterior vaginal wall after unsuccessful surgery procedures by employing a perineal skin flap. The repeated enterocele was treated by using a skin flap during a LeFort colpocleisis, and Labhard perineoplasty was added. In some patients obliterative surgery may fail, especially those with recurrent POP. The use of a perineal skin flap in reoperation of POP is a possible solution for surgical treatment of recurrent enterocele with poor quality of the posterior vaginal wall. This patient’s postoperative course was uneventful. At her follow-up visit 2 months later an examination revealed excellent healing. Obliterative surgery can be an option for women with large prolapses who are not sexually active and do not plan to be so in the future. Le Fort with perineal skin flap and Labhard high perineoplasty is one possible surgical technique which can treat recurrent pelvic organ prolapse in older patients where previous procedures have failed.

Objective To determine the long-term rate of posterior compartment prolapse (PCP) occurrence after native tissue repair of the anterior compartment with anterior vaginal wall suspension (AVWS) procedure. Methods An institutional review board approved surgical prolapse database was reviewed for women who underwent AVWS for any degree of anterior compartment prolapse with minimum of 6-month follow-up and no history of apical or posterior compartment repair. Demographic data, smoking status, parity, and uterine status were collected. The primary outcome was need for secondary PCP repair. Results A total of 300 women met inclusion criteria with a mean age of 63.8 ± 10.8 years, mean BMI of 26.1 ± 6.2 kg/m2, and a mean parity of 2.5 ± 1.4. At the time of AVWS 46 women (15%) had uterine-sparing AVWS, 74 (25%) had concomitant hysterectomy, and 180 (60%) had prior hysterectomy. Forty-eight women (16%) had secondary posterior compartment repair for PCP (60% abdominal route, 40% done vaginally) over a mean follow-up of 7.1 ± 4.4 years. Conclusion At long-term follow-up, less than 20% of women undergoing AVWS underwent PCP repair.

MA¼llerian and Gartner duct cysts are rare embryological remnants of the vaginal wall. Their sizes may vary from one to several centimeters. Dyspareunia, pelvic pain, pressure, bulging mass and urinary incontinence are the most frequent presenting symptoms associated with these vaginal cysts. The purpose of this report is to present a case of hysterocele associated with MA¼llerian vaginal cyst.

Introduction: The overstretching of the posterior vaginal wall can cause a rectocele or enterocele. Although these defects can be asymptomatic, they often cause discomfort such as bulging ...

Complex pelvic organ prolapses may develop after radical cystectomy. We report a case of an anterior enterocele, which was repaired vaginally and using mesh placed extraperitoneally. We present the case of a 75-year-old woman who underwent a radical cystectomy and ileal conduit diversion for treatment of invasive bladder cancer. She developed a vaginal vault prolapse 4 months later. She then underwent a vaginal repair and sacrospinous fixation using no mesh. She then presented to our clinic 4 months later with a prolapse recurrence involving an anterior enterocele. She was treated successfully with a transvaginal mesh repair for reconstruction of the anterior vaginal wall, iliococcygeal suspension and colpocliesis. We argue that there is a place for the vaginal use of mesh in the surgical treatment of an anterior enterocele when a substantial loss of endopelvic fascia is encountered. The extraperitoneal technique seems to be a good option while reducing the surgical risks for the patient.

Female reproductive tissues undergo significant alterations during pregnancy, which may compromise the structural integrity of extracellular matrix proteins. Here, we report on modifications of elastic fibers, which are primarily composed of elastin and believed to provide a scaffold to the reproductive tissues, due to parity and parturition. Elastic fibers from the upper vaginal wall of virgin Sprague Dawley rats were investigated and compared to rats having undergone one, three, or more than five pregnancies. Optical microscopy was used to study fiber level changes. Mass spectrometry, 13C and 2H NMR, was applied to study alterations of elastin from the uterine horns. Spectrophotometry was used to measure matrix metalloproteinases-2,9 and tissue inhibitor of metalloproteinase-1 concentration changes in the uterine horns. Elastic fibers were found to exhibit increase in tortuosity and fragmentation with increased pregnancies. Surprisingly, secondary structure, dynamics, and crosslinking of elastin from multiparous cohorts appear similar to healthy mammalian tissues, despite fragmentation observed at the fiber level. In contrast, elastic fibers from virgin and single pregnancy cohorts are less fragmented and comprised of elastin exhibiting structure and dynamics distinguishable from multiparous groups, with reduced crosslinking. These alterations were correlated to matrix metalloproteinases-2,9 and tissue inhibitor of metalloproteinase-1 concentrations. This work indicates that fiber level alterations resulting from pregnancy and/or parturition, such as fragmentation, rather than secondary structure (e.g. elastin crosslinking density), appear to govern scaffolding characteristics in the female reproductive tissues.

Cervical cancer is a leading cause of death for women in low resource settings. Visual methods for cervical cancer screening have become more widespread. To improve diagnosis of cervical precancerous lesions, a smartphone-based mobile colposcope was developed that uses auxiliary lens and light source inside a custom-designed case. However, acquiring a sharp image in a clinical setting using the mobile colposcope is tricky. For example, trying to use the phone’s auto-focus functionality struggles with the external lens placed in front of the phone’s internal lens, because translation of the internal lens has a non-trivial effect the image. Moreover, auto-focus algorithm struggles with the high contrast caused by artifacts as patients’ vaginal walls and pubic hair. A more robust algorithm that feeds commands back to the phone’s camera module is needed. Previously, a classifier that measures image sharpness was presented. Implementing a method to correct for an out of focus image requires manipulating the smartphone’s camera control parameters. This can be done either through the phone’s operating system (Camera 2 API) or through the manufacturer’s camera interface (Samsung Camera SDK), as called for from the application. This paper reviews how manipulations in a smartphone app affects image quality. In addition to image sharpness, analyses of brightness and color are also presented. Special apps that sweep through camera conditions were developed. Sample images from both anatomical models and calibration targets are given.

Obstructed labour is a well-known clinical entity in maternity units, cephalopelvic disproportion being the most common cause. Here, we report a rare case of obstructed labour resulting from a large vesical calculus. The patient was a referred case from a district hospital for delayed progress of labour. The diagnosis of large vesical calculus causing labour obstruction was made by doing a vaginal examination. On vaginal examination, a large calculus of apparent size ~7 cm × 6 cm was palpated behind the anterior vaginal wall, which was preventing the descent of the head of the fetus. An emergency caesarean section was performed with simultaneous removal of vesical calculus by cystotomy. The postoperative period was uneventful.

Treatment of rectovaginal fistulas (RVFs) is extremely difficult. No standard surgical procedure is accepted worldwide. The aim of this article was to evaluate a minimally invasive procedure for the repair of mid-low rectovaginal fistula. This is a retrospective review of 17 patients who underwent minimally invasive surgery for the repair of mid-low rectovaginal fistulas (located in the lower or middle one-third of the vaginal wall) at our center between August 2016 and October 2018. The anal approach was adopted for 12 patients: 6 patients were treated directly by rectal mucosal advancement flap (RMAF) with transanal endoscopic surgery (TES), while the other 6 patients underwent initial TES exploration followed by RMAF procedure under direct vision. The vaginal approach was adopted for 5 patients: 3 patients were treated under TES directly and the other 2 were treated under direct vision after initial TES exploration. A total of 9 (52.94%) patients received diverting ileostomy—5 anal approach patients and 4 vaginal approach patients. Median age of the patients was 46 years (range 10–76 years), and median BMI was 21.9 (range 17.9–28.1). Median operative time was 75 min (range 60–120 min), and median duration of postoperative hospital stay was 8 days (range 6–15 days). Recurrence was seen in 3/12 anal approach patients vs. 0/5 vaginal approach patients. Both the median preoperative and the median postoperative Wexner score were 0 (range 0–2). The median follow-up time was 8 months (range 2–24). No severe complications occurred in any patient. The TES procedure for the treatment of mid-low rectovaginal fistulas avoids any incision of the abdomen and perineal area and appears to be a safe and feasible procedure. This minimally invasive technique is still evolving and is likely to gain wide acceptance in the near future.

The patient is an 87-year-old female who presented with a history of constipation and bothersome rectal prolapse that required manual rectal prolapse reduction. On exam, she was found to have full-thickness rectal prolapse and stage II posterior vaginal wall pelvic organ prolapse. She desired definitive surgical management of her prolapse and opted for a laparoscopic suture rectopexy and posterior vaginal wall repair and perineorrhaphy. She had anorectal physiology and urodynamic testing, as well as a defecography before surgery to assist surgical planning. The surgery was uncomplicated. She was discharged on postoperative day one and her postoperative recovery was unremarkable.

Introduction More than one million fertilization cycles are performed every year. The incidence of serious complications associated with transvaginal oocyte pick-up is low, but the procedure is not risk-free. Risks are inherent to procedures in which thin needles and sharp instruments are introduced into the vaginal wall and ovarian capsule to access the ovaries. Case description A 45-year-old patient reported urinary discomfort and difficulty urinating after her second cycle, 12 hours after oocyte pick-up. She had visible hematuria with small blood clots. Transvaginal ultrasound examination performed 24 hours after pick-up showed a heterogeneous intravesical image suggestive of a clot; her bladder measured 23x19mm. She was afebrile and in good condition. The patient was managed conservatively and offered fluids. The clot was expelled within a matter of hours. This case of a bladder hematoma was the first in the 21 years of a clinic where all procedures are guided by ultrasonography with clear visualization of the tip of the needle throughout the 15-20 minutes of the procedure. Patients submitted to ultrasound-guided transvaginal oocyte pick-up procedures in IVF protocols must be informed of this rare potential complication.

Ideal animal models are needed to reflect the changes in the biochemical and biomechanical properties of the vagina that occur in pelvic organ prolapse (POP). In this study, we aimed to demonstrate the short and long-term effect of menopause on the biochemical and biomechanical properties of rat anterior vaginas. Here, Sprague-Dawley rats were bilaterally ovariectomized to induce menopause. Rats without ovariectomy served as the normal control group (n=12). The histology changes and the expression of collagen I, III, and a-SMA were assessed to indicate the biochemical changes in the vagina 2 weeks, 4 weeks, and 16 weeks after ovariectomy (n=6 for 2 and 4 weeks, n=12 for 16 weeks). Uniaxial biomechanical testing was conducted in the control group and ovariectomized rats 16 weeks after ovariectomy. Compared with the control group, the ovariectomy group showed a significant increase in the expression of collagen I 2 weeks after ovariectomy, while collagen III showed a declining trend. Two weeks after ovariectomy, the smooth muscle bundles began to become disorganized, and the fraction of smooth muscle in the nonvascular muscularis of the proximal vagina was significantly decreased (P

Objective: To investigate the effect of platelet-rich plasma (PRP) injection to the lower one-third of the anterior vaginal wall on sexual function, orgasm, and genitalperception in women with sexual dysfunction.Materials and Methods: Four sessions of PRP were administered to the anterior vaginal wall of 52 female patients with sexual dysfunction and orgasmic disorder[Female Sexual Function Index (FSFI) total score ?26 orgasmic subdomain score ?3.75]. Prior to the PRP administrations in each session, the FSFI validated inTurkish, the Female Genital Self-Image Scale (FGSIS), the Female Sexual Distress Scale-Revised (FSDS-R), and Rosenberg’s Self-Esteem Scale were used and in thefinal follow-up, and the Patient Global Impression of Improvement (PGI-I) was performed and the results were analyzed.Results: Following the application of the PRP, the total FSFI score was observed as 27.88±4.80 and the total score was 26 and above in 50% of the patients(p

Introduction: Large posterior vaginal wall inclusion cysts are rarely reported. According to our review, this case is the largest such cyst reported after posterior vaginal repair. Aim: We present the successful excision of a very large posterior vaginal wall inclusion cyst that developed after posterior vaginal wall repair. Methods: A 44 year old patient presented with a 7 cm symptomatic posterior vaginal wall cyst 5 years after posterior vaginal wall repair. She underwent aspiration of the cyst twice with recurrence before successful surgical excision. Results: The patient recovered without complications. Histopathology revealed a benign inclusion cyst. Conclusions: Although most epidermal inclusion cysts are asymptomatic and can be managed expectantly, cysts that enlarge or become symptomatic should be excised surgically.

To explore the feasibility of three-dimensional (3D) transperineal tomographic ultrasound in evaluating pelvic floor support of the urethra in women. Three-dimensional transperineal ultrasound volume data sets of 50 women with stress urinary incontinence (SUI) and 25 women without SUI were obtained for analysis. Pelvic floor support of the urethra was evaluated by studying the relationship between the urethra and vagina in vaginal cross section and quantified by estimating the urethral depression (UD) rate. The extent of paravaginal support at level II was also evaluated in tomographic ultrasound imaging (TUI) mode in all participants. Two-sample t-test and Mann-Whitney U test were used for statistical analysis. The extent of paravaginal support at level II showed no difference between the two groups. Posterior depression of the urethra into the anterior vaginal wall was increased in SUI (P

The purpose of this study is to investigate the feasibility and performance of a stationary, non-focused dual-sectored tubular transurethral ultrasound applicator for thermal exposure of tissue regions adjacent to the urethra for treatment of stress urinary incontinence (SUI) through acoustic and biothermal simulations on 3D anatomical models. Parametric studies in a generalized tissue model over dual-sectored ultrasound applicator configurations (acoustic surface intensities, lateral active acoustic output sector angles, and durations) were performed. Selected configurations and delivery strategies were applied on 3D pelvic anatomical models. Temperature and thermal dose distributions on the target region and surrounding tissues were calculated. Endovaginal cooling was explored as a strategy to mitigate vaginal heating. The 75-90° dual-sectored transurethral tubular transducer (3.5mm outer diameter (OD), 14mm length, 6.5MHz, 8.8-10.2W/cm2) and 2-3-min sonication duration were selected from the parametric study for acoustic and biothermal simulations on anatomical models. The transurethral applicator with two opposing 75-90° active lateral tubular sectors can create two heated volumes for a total of up to 1.8cm3 over 60 EM43°C, with at least 10mm radial penetration depth, 1.2mm urethral sparing, and no lethal damage to the vagina and adjacent bone (

Objective To investigate the relationship between endoplasmic reticulum stress (ERS) and the pathogenesis of stress urinary incontinence (SUI) in postmenopausal women. Methods Anterior vaginal wall tissue was collected from postmenopausal women with SUI and control subjects. Western blotting was performed for glucose-regulated protein (GRP78), inositol-requiring enzyme 1(IRE1), protein kinase-like endoplasmic reticulum kinase (PERK), activating transcription factor 6 (ATF6), C/EBP-homologous protein (CHOP), and B-cell lymphoma 2 (Bcl-2). Additionally, mRNA expression levels of PERK, activating transcription factor 4 (ATF4), and CHOP were examined by real-time polymerase chain reaction. Results GRP78 protein and mRNA expression levels were significantly lower in women with SUI, compared with control subjects. PERK and p-PERK expression levels were higher in women with SUI than in control subjects. However, no differences in IRE1 or ATF6 expression levels were observed in either group. Notably, higher CHOP and lower Bcl-2 protein expression levels were detected in women with SUI, compared with control subjects. Furthermore, PERK, ATF4, and CHOP mRNA expression levels were significantly higher in women with SUI than in control subjects. Conclusions Alterations of ERS markers in SUI suggest that ERS may be involved in the development of SUI in postmenopausal women.

The synthetic midurethral sling has become the gold standard for treatment of stress urinary incontinence since its introduction more than 20 years ago. With its utilization, the incidence of mesh-related complications has also increased. Mesh exposure and perforation are 2 common mesh complication scenarios that pelvic floor surgeons should be prepared to treat. This article highlights preoperative, perioperative, and postoperative factors to minimize the chance of vaginal wall mesh exposure or perforation of mesh into the lower urinary tract. It also summarizes common presenting symptoms, suggested evaluation and a range of treatment options.

Background We aim to assess the long-term efficacy of transvaginal high uterosacral ligament suspension (HUS) procedure for middle compartment defect-based pelvic organ prolapse (POP). Methods We performed a retrospective review of 84 women with middle-compartment defect-based POP who underwent transvaginal HUS as the primary surgical treatment without mesh augmentation from January 2007 to January 2019. All 84 patients manifested ≥ grade-II middle-compartment defect-based POP. Follow-up visits were performed 2, 6 and 12 months after surgery and then annually, including questionnaires and clinical examination using pelvic organ prolapse quantitation system (POP-Q). Surgical success required to fulfill all three of these criteria: (I) anterior or posterior vaginal wall prolapsed the leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (II) the absence of POP symptoms as reported on the PFDI-20 question No. 3 ("do you usually have a bulge or something falling out that you can see or feel in your vaginal area?"); and (III) no prolapse re-operations or pessary use during the study period. Results Of 84 women, 56 cases (66.7%, 56/84) were evaluated at a ≥5-year follow-up. The 5-year recurrence rates for patients with prolapse of either the anterior vaginal wall, vaginal vault, or posterior vaginal wall, or prolapses in multiple sites, were 7.1% (4/56), 0, 1.8% (1/56), and 3.6% (2/56), respectively. The surgery success rate was 87.5% (49/56). None of the recurrent women underwent retreatment. The satisfaction rate was 91.1% (51/56). Conclusions Transvaginal HUS without mesh augmentation is a safe and effective procedure in the surgical treatment of patients with middle-compartment defects. Anatomical, functional, and subjective outcomes were very satisfactory.

Pelvic organ prolapse (POP) is characterized by weakening of the connective tissues and loss of support for the pelvic organs. Collagen is the predominant, load-bearing protein within pelvic floor connective tissues. In this study, we examined the nanoscopic structures and biomechanics of native collagen fibrils in surgical, vaginal wall connective tissues from healthy women and POP patients. Compared to controls, collagen fibrils in POP samples were bulkier, more uneven in width and stiffer with aberrant D-period. Additionally, the ratio of collagen I (COLI) and collagen III (COLIII) is doubled in POP with a concomitant reduction of the amount of total collagen. Thus, POP is characterized by abnormal biochemical composition and biophysical characteristics of collagen fibrils that form a loose and fragile fiber network accountable for the weak load-bearing capability. The study identifies nanoscale alterations in collagen as diagnostic markers that could enable pre-symptomatic or early diagnosis of POP. From the Clinical Editor Pelvic organ prolapse (POP) occurs due to abnormalities of the supporting connective tissues. The underlying alterations of collagen fibers in the connective tissues have not been studied extensively. In this article, the authors showed that collagen fibrils in POP patients were much different from normal controls. The findings may provide a framework for the diagnosis of other connective diseases.

Pelvic organ prolapse, characterized by a descent of the vaginal walls or vaginal apex, can be treated surgically in symptomatic women who decline or have failed conservative management. Because prolapse can recur after surgery, mesh and biologic grafts have been developed to augment repairs. Use of transvaginal mesh materials quickly increased in the early twenty-first century; however, since the FDA warnings about potential serious complications from transvaginal mesh in 2008 and 2011, use has decreased dramatically, and many mesh products were removed from the market. Even through the peak of mesh use in prolapse surgery, native tissue repairs have remained the most common type of repair.

Cystocele is the most common pelvic organ prolapse. It is defined as the descent of the bladder into the anterior vaginal wall. Aging is significantly associated with the prevalence and severity of pelvic organ prolapse. Treatment may be conservative or surgical according to symptoms, prolapse degree and not forgetting both patient and doctor preferences. Identify the most efficient surgical treatment to treat cystocele and its recurrences. Scientific literature was reviewed searching PubMed/MEDLINE database for articles published between 1996 and 2015 and using the terms pelvic organ prolapse, cystocele, mesh surgery, traditional repair, pelvic organ prolapse recurrence, complications, sexual function. There are two different surgical approaches for the treatment of cystocele: traditional repair and mesh repair. Prosthetic treatment gives higher anatomical success rate and fewer recurrence while traditional anterior repair has less complications. Surgical treatment in general improves both the anatomical success rate and the quality of life. The choice of surgery, between traditional and mesh repair, has to be personalized related to the prolapse grade and women tissues.

Vulvovaginal candidosis (VVC) is a common gynaecological disorder that is delineated by the inflammation of vaginal wall and it is caused by the opportunistic fungal pathogen Candida species. In fact, three out of every four women will experience at least one occasion of VVC during some point in their lives. Although uncomplicated VVC is relatively harmless, the complicated VVC such as recurrent attack often creates restlessness and depression in the patients, thus greatly affects their quality of life. Managements of VVC are usually associated with the use of antimycotic suppositories, topical cream or oral agents. These antimycotic agents are either available over-the-counter or prescribed by the clinicians. In recent decades, the rise of clinical challenges such as the increased prevalence of resistant Candida strains, recurrent VVC infection and adverse effects of multidrug interactions have necessitated the development of novel therapeutic or prophylactic options to combat the complicated VVC in the future. In this review, we discuss the current antimycotic treatments available for Candida vaginitis and the problems that exist in these seemingly effective treatments. Besides, we attempt to contemplate some of the future and prospective strategies surrounding the development of alternative therapeutic and prophylactic options in treating and preventing complicated VVC respectively.

OBJECTIVE The aim of the study was to evaluate if vaginal focal depth measurement could be a noninvasive method to quantify vaginal wall thickness. METHODS Postmenopausal women undergoing topical estrogen therapy because of vaginal atrophy (VA) were recruited. VA was diagnosed based on the presence of symptoms and vaginal pH at least 5.5. The control group consisted of women above 40 years without VA. Focal depth measurements were performed before and after treatment using the Cytocam-Incident Dark Field device assessing the distance between the subepithelial microcirculation and the epithelial surface. Measurements were performed before and after treatment in the intervention group and at two different time points in the control group. Vaginal pH was measured. Symptoms were evaluated using the most bothersome symptom approach. RESULTS Eight women with VA and nine controls were included. Pretreatment median focal depth was not significantly different between both groups. Pretreatment focal depth more than doubled after a median of 7 weeks of topical estrogen treatment (80 μm [interquartile range 80-120 μm] vs 220 μm [148-248 μm], P = 0.02), whereas the measurements in the control group did not change. Pretreatment vaginal pH differed between both groups (5.5 vs 5.1, respectively, P

Anatomy of the female pelvic viscera was investigated before and after the Tension free Vaginal tape (TVT-O). Forty patients were included in the study. Surgery was performed between 2009 and 2012 in Clinic of Urology (Clinical Center Nis) and Department of Urology (Municipal Hospital Prokuplje). Stress Urinary Incontinence (SUI) and anterior vaginal wall prolapse was confirmed in all patients. In all patients with anterior vaginal wall prolapse (grade≥2) both tension free vaginal tape (TVT-O) and anterior vaginal wall repair were performed. Pelvic Organ Prolapse Quantification (POPQ) system was used for the evaluation of prolapse before and after the surgery. Mean age of patients was 61 years. Spinal anesthesia was performed in thirty patients and general anesthesia in 10 patients. Intraoperative blood loss was under 50 ml. There were no bladder, nerve and blood vessels injuries . Thirty eight out of forty patients (95%) were satisfied with the outcome of the surgery. There was a significant correction of prolapse after the surgery. Recurrence of prolapse was found in patients with the high grade prolapse before the surgery, as well as, in patients with the history of previous anterior vaginal repair. Pelvic organ prolapse, congenital or acquired, is supported by the congenital weakness of the pelvic floor.

Leiomyomas are classified as benign mesenchymal neoplasms and consist of smooth muscle cells with variable amounts of fibrous stroma. The tumours occur most frequently in the uterus, affecting 20–30% of women of reproductive age but vaginal leiomyomas are rare with only around 300 cases reported since the first case was described in 1733. These tumours are thought to arise from Mullerian smooth muscle cells in the sub-epithelium of the vagina. Vaginal leiomyomas are usually situated in the anterior vaginal wall. This article reports a case of primary leiomyoma arising from the left lateral vaginal wall, which presented with vaginal discharge and a lateral vaginal wall mass.

The article contains a whole series of judgments about these two operations. The author is a great supporter of sewing the uterus to the abdominal wall when this organ falls out and its bends posteriorly. In case of loss, it connects this operation with a partial resection of the vaginal wall.

In the originally published version of the Abstracts article, the figure presented in Poster 204 entitled "Exosomes derived from fibroblasts in anterior vaginal wall associated with the pathogenesis of female stress urinary incontinence by promoting fibroblasts migration".

Vaginal wall cysts are uncommon and are broadly classified according to the lining epithelium of the cyst into epithelial inclusion cysts, embryonic (Mullerian and Gartner’s) cysts and urothelial cysts. Mullerian cysts are the commonest congenital cysts of the vagina. We present a case report of a 36 yearold pregnant woman presented the first time in her life with anterior vaginal wall cyst on her second pregnancy. A systematic clinical approach such as history, examination and investigations (imaging studies) was an aid to plan out the management.

Vaginal prolapse rarely complicates pregnancy. We experienced a 36-year-old, gravida 3, para 1 woman who presented at 37 weeks’ gestation with gestational diabetes mellitus and a large anterior vaginal prolapse that could not be reduced manually or by bed rest. After obtaining consent, a cesarean section was successfully performed, and a live neonate delivered. The prolapsed anterior vagina recovered spontaneously following the cesarean operation. A vaginal prolapse in pregnancy is rare. Elective or emergency cesarean section is a possible treatment option when the prolapse cannot be reduced manually or by bed rest. Our case highlights the importance of routine obstetric examinations for early detection of a vaginal wall prolapse.

A longitudinal vaginal septum can be obstructive or nonobstructive. We report on an adult woman who presented with involuntary fluid loss per vagina and had a partially obstructive longitudinal vaginal septum. A 36-year-old nulliparous female presented with malodorous, clear, leakage per vagina that she described as “urinary incontinence.” Examination revealed a fluid-filled fluctuant anterior vaginal wall with a draining sinus. Imaging revealed a solitary right kidney with duplicated ectopic fluid-filled ureters inserting into a partially obstructed left hemivagina with a longitudinal vaginal septum. A longitudinal vaginal septum may present in adulthood with the complaint of urinary incontinence.

Aim Post-partum hematomas are a serious obstetrical complication. Choosing treatments for post-partum hematomas is difficult, and the application of transcatheter arterial embolization remains unclear. We aimed to clarify the clinical characteristics, identify the treatment indications and create a treatment algorithm for post-partum hematomas. Methods Fifty-four patients with post-partum hematomas were enrolled. Hematomas were categorized according to location: upper vaginal, lower vaginal and vulvar. Blood loss, treatment methods and other clinical data were collected from the patients' medical records and analyzed retrospectively. Results Five, 19 and 30 patients had upper vaginal wall, lower vaginal wall and vulvar hematomas, respectively. All upper vaginal wall hematomas required transcatheter arterial embolization to control bleeding, and the average blood loss was 2473 ± 1689 mL. Most lower vaginal wall hematomas were treated surgically; however, two patients required transcatheter arterial embolization, and the average blood loss in these patients was much higher (2010 ± 1145 mL) than that in patients with lower vaginal wall hematomas (395 ± 316 mL). No patient with vulvar hematomas was treated with transcatheter arterial embolization. Two and four patients with vulvar and lower vaginal wall hematomas, respectively, were managed with observation. Conclusion We created an algorithm for post-partum hematoma management. Post-partum hematoma location should guide treatment selection. Transcatheter arterial embolization should be selected for upper vaginal wall hematomas. Most lower vaginal wall hematomas are treatable with surgery, but transcatheter arterial embolization should be considered for hemostasis in difficult cases. Management with observation may also be possible for lower vaginal wall and vulvar hematomas.

Transmissible venereal tumour (TVT) grows mainly on the genitals of dogs. When such lesions develop in the vaginal passage, the process of clinical examination, diagnosis, and monitoring of therapeutic response are crucial in veterinary practice. The objective of this study was to investigate the usefulness of two-dimensional trans-perineal ultrasonography to monitor the therapeutic response of vincristine sulphate on intravaginal TVT in dogs. Twelve female dogs having lesions confirmed as TVT with cytological evaluation were used. TVT were categorized as multilobular (n=7), solitary (n=5), and heterogeneous (n=12). The maximum transverse diameter of tumour was assessed ultrasonographically while treating with vincristine sulphate 0.025 mg/kg, IV at weekly intervals. Owners were informed about the side effects of chronic vincristine sulphate chemotherapy such as development of pancytopenia, inappetence, and alopecia. Dogs were monitored for such adverse reactions during the study. The average maximum transverse diameter of tumour was 3.05±1.31 cm (range, 1.32 to 5.8 cm) before the treatment. A variation of therapeutic effect on tumour size was observed with trans-perineal ultrasonography. A significant reduction of the lesions was recorded between two to five weeks of the treatment in 11 dogs (P=0.00), with the highest reduction recorded one week after the treatment (P=0.01). Eight dogs showed thickened and hyperechoic foci on the vaginal wall with the highest average thickness of 0.36±0.08 cm after the complete remission of TVT. Based on the results in this study, it could be concluded that trans-perineal ultrasonography is a simple and noninvasive diagnostic modality to characterize and monitor the therapeutic effect of vincristine sulphate in dogs affected with intravaginal TVT in clinical practice.

A 22-year-old woman met with road traffic accident 6 months back following which she underwent exploratory laparotomy with intraperitoneal bladder rupture repair. She presented with urethrovaginal fistula due to a fragment of fractured pubic bone impinging into the anterior vaginal wall. The findings were confirmed on CT scan and cystoscopy. The patient was managed with removal of the bony spicule and transvaginal repair of urethrovaginal fistula with Martius fat pad interposition.

Video Objective To demonstrate a minimally invasive technique used on approaching of a large vaginal fibroid. Setting A 30-year-old woman with important transvaginal bleeding which started 6 months ago. A MRI was perfomed and showed the presence of an heterogeneous image with slightly lobed contours, located on the upper third of the right vaginal wall, measuring 6,4 × 6,4 × 5,9cm, subsequentaly. Interventions The patient was admitted to a terciary hospital of the Fortaleza - Brazil (Cesar Cals Hospital) for a video- assisted vaginal myomectomy due to a large vaginal fibroid as described by a previous MRI. Intraoperatively, with the aid of a laparoscopy was verified that the fibroid extended deep into the pararectal and parametrial spaces, being necessary to approach this spaces to identify noble structures, such as ureter and pelvic nerves. Surgical procedure was successfully completed and the patient was discharged on the day after surgery. Conclusion Vaginal fibroids are a rare condition and commonly need a vaginal approach surgery. However, in some cases it requires both abdominal and vaginal approach when de fibroids are so extensive and infiltrative. This video uses a particularly challenging case to demonstrate a laparoscopic assisted vaginal myomectomy as a safe procedure for cases like this.

Although the underlying mechanisms of pelvic organ prolapse (POP) remain unknown, disruption of elastic fiber metabolism within the vaginal wall extracellular matrix has been highly implicated. It has been hypothesized that elastic fiber fragmentation correlates to decreased structural integrity and increased risk of prolapse; however, the mechanisms by which elastic fiber damage may contribute to prolapse are poorly understood. Further, the role of elastic fibers in normal vaginal wall mechanics has not been fully ascertained. Therefore, the objective of this study is to investigate the contribution of elastic fibers to murine vaginal wall mechanics. Vaginal tissue from C57BL/6 female mice were mechanically tested using biaxial extension-inflation protocols before and after intraluminal exposure to elastase. Elastase digestion induced marked changes in the vaginal geometry, and biaxial mechanical properties, suggesting that elastic fibers may play an important role in vaginal wall mechanical function. Additionally, a constitutive model that considered two diagonal families of collagen fibers with a slight preference towards the circumferential direction described the data reasonably well before and after digestion. The present findings may be important to determine the underlying structural and mechanical mechanisms of POP, and aid in the development of growth and remodeling models for improved assessment and prediction of changes in structure-function relationships with prolapse development. Keywords: vaginal wall, women's health, mechanical testing, pelvic floor disorders, elastic fibers Disclosures: none.

Tujuan: mengetahui pengaruh pemberian aspirin 125 mg/hari terhadap penurunan resistensi pembuluh darah arteri uterina pada ibu hamil USG doppler velocimetry arteri uterina abnormal usia kehamilan 16-24 minggu.Bahan dan Metode: Penelitian ini merupakan penelitian pra-eksperimental pre-test post-test one group design. Subjek penelitian adalah ibu hamil dari puskesmas Mulyorejo dan Kalijudan Surabaya, usia kehamilan 16-24 minggu dengan hasil USG doppler velocimetry arteri uterina abnormal. Pemeriksaan USG doppler arteri uterina dilakukan di Departemen/SMF Obstetri Ginekologi Fakultas Kedokteran Universitas Airlangga-RSUD Dr. Soetomo, divisi Feto-Maternal, sebelum dan sesudah pemberian aspirin 125 mg/hari selama 4 minggu. Hasil pemeriksaan USG doppler velocimetry arteri uterina dibagi menjadi empat tingkatan yaitu; normal bila RI < 0,58 tanpa adanya notching, tingkat I jika RI > 0,58 tanpa adanya notching, tingkat II RI < 0,58 disertai notching dan tingkat III bila RI > 0,58 disertai adanya notching.Hasil: Dari 99 subjek penelitian dengan hasil USG doppler velocimetry arteri uterina abnormal yaitu; 81 orang tingkat I, 2 orang tingkat II dan 16 orang tingkat III. Hasil pemeriksaan USG doppler velocimetry arteri uterina setelah diberikan aspirin 125 mg/hari selama 4 minggu, didapatkan 76 subjek dengan hasil USG doppler arteri uterina yang menjadi normal dan 23 subyek tetap dengan hasil USG abnormal (20 orang tingkat I dan 3 orang ibu hamil tingkat III). Aspirin dosis rendah dapat menurunkan resistensi arteri uterina secara bermakna, dengan hasil p=0,0001 (p

In the light of the historical perspective described by Cundiff et al. (1998), the long lasting tradition on posterior repair can be appreciated [1]. It was the early nineteenth century when the first report became apparent: Fricke JC in 1833 described elytrorrhaphy as a technique to denudate and close the posterior vaginal wall to repair genital prolapse. Then Simon G. in 1867 firstly introduced the term posterior colporrhaphy as a more aggressive levator ani muscle plication in the inferior vaginal portion to create an inferior shelf and a superior pocket. The same concept was then adopted by Hegar (1870) who introduced the colpoperineorrhaphy with the classic triangular denudation of the perineal body.